Managed Care Activities means any of the following services or activities, whether provided on paper, in person, electronically, or in any other form and whether performed for or on behalf of the Organization or by the Organization for itself or on behalf of any other party for a fee: Provider Selection; Utilization Review; Quality Improvement Organization Programs; advertising, marketing, selling, or enrollment for health care, consumer directed health care, behavioral health, prescription drug, dental, vision, long or short term disability, automobile medical payment, or workers’ compensation plans; Claim Services; establishing health care provider networks including tiered networks; provision of information with respect to tiered networks and/or consumer directed health care plans, including cost and quality information regarding specific providers, services or charges; reviewing the quality of Medical Services or providing quality assurance; design or implementation of financial incentive plans; design and/or implementation of Pay for Performance Programs; wellness or health promotion education; development or implementation of clinical guidelines, practice parameters or protocols; triage for payment of Medical Services; calculation of medical loss ratio and related distribution; and services or activities performed in the administration or management of health care, consumer directed health care, behavioral health, prescription drug, dental, vision, long or short term disability, automobile medical payment, or workers’ compensation plans.
Managed Care Activities means any of the following services or activities performed by or on behalf of the Insured for or under any workers’ compensation plan, life insurance plan, disability plan, or health care plan, including an automobile insurance plan, behavioral health plan, prescription drug plan, dental plan or vision plan:
Managed Care Activities means any of the following services or activities, whether provided on paper, in person, electronically, or in any other form and whether performed for or on behalf of the Organization or by the Organization for itself or on behalf of any other party for a fee: Provider Selection; Utilization Review; advertising, marketing, selling, or enrollment for health care, consumer directed health care, behavioral health, prescription drug, dental, vision, long or short term disability, automobile medical payment, or workers’ compensation plans; Claim Services; establishing health care provider networks including tiered networks; provision of information with respect to tiered networks and/or consumer directed health care plans, including cost and quality information regarding specific providers, services and/or charges; reviewing the quality of Medical Services or providing quality assurance; design and/or implementation of financial incentive plans; design and/or implementation of Pay for Performance Programs; wellness or health promotion education; development or implementation of clinical guidelines, practice parameters or protocols; triage for payment of Medical Services; and services or activities performed in the administration or management of health care, consumer directed health care, behavioral health, prescription drug, dental, vision, long or short term disability, automobile medical payment, or workers’ compensation plans.
Examples of Managed Care Activities in a sentence
Table 2.1: Typical Managed Care Activities to Control Costs Gatekeepers/Primary Care Physicians generally coordinate patient care and control patient access to specialists or out-of-network providers based on referral protocols.
The topics presented were as follows: Managed Care Activities, Presentation on Consumer Directed Services for Waiver Services, Updates from DADS and DSHS, Update from HHSC and CMS on 1115 Waiver Activity, Billing Rehab in a Managed Care Environment, Revenue Maximization Committee Update and Public Funds Investment Training was provided.
Managed Care Activities UpdateThe Governor has asked DHHS to issue a request for proposal (RFP) to select a managed care company after Mercer, the state’s actuarial consultant, has completed the cost analysis, which is expected by October.